tbuckley/cabot-search huggingface dataset:
Barriers to BRCA, HRD, and HRRm testing despite increased utilization: U.S. physician survey results.
Authors: Elizabeth A. Szamreta, Ning Ning, Bianca Jackson, Ruchit Shah, Jyoti Aggarwal, Gboyega Adeboyeje, Arif Hussain
Journal: Journal of Clinical Oncology (2022)

380 Background: Despite increasing use of breast cancer (BRCA) gene and homologous recombination deficiency/ homologous recombination repair gene mutation(s) (HRD/HRRm) testing, barriers to uniform adoption of these tests to inform patient management remain. The purpose of this study was to identify potential barriers to BRCA, HRD, and HRRm testing from the physician’s perspective. Methods: A cross-sectional online survey was sent to a US representative sample of primary care providers, medical oncologists, urologists, and surgeons, including both users and non-users of the tests. Physician demographics, practice characteristics, barriers (reimbursement, knowledge, logistical), and strategies to alleviate barriers were collected. Descriptive analysis was conducted via SASv9.4. Results: Three hundred physicians participated in this survey (49.7 years of age and 17.9 years in clinical practice on average). Most respondents (94.3%) reported at least 1 barrier to test use (BRCA 94.0%, HRD 91.3%, HRRm 90.3%). The most common barrier was the challenge in obtaining prior authorizations (BRCA 74.0%, HRD 80.0%, HRRm 83.5%). Other commonly reported barriers included test not being covered by insurance (BRCA 64.8%, HRD 61.8%, HRRm 67.6%), insurance policies restricting certain genomic tests to a particular lab/test provider (BRCA 64.0%, HRD 66.5%, HRRm 67.4%), and unclear/inconsistent payer policies for test coverage (BRCA 63.6%, HRD 63.6%, HRRm 66.7%). Physicians were more likely to report barriers to HRD/HRRm testing compared to BRCA testing. More reimbursement-related barriers were reported by primary care providers vs. other physicians. Physician/patient education, collaboration with specialists, standardization in test guidelines, and improvement in test interpretation were reported as key strategies to improving further test adoption in patient management. Conclusions: The results highlight that physicians have concerns about reimbursement-related, knowledge-related, and logistical barriers that may impact clinical optimization. Addressing these barriers to improve oncology care is of utmost importance.[Table: see text]
Evaluating the use of web versus mobile devices for ePRO reporting and severe symptom responses at 6 cancer centers.
Authors: Christine Cronin, Angela Tramontano, Deborah Schrag, Sandra L. Wong, Raymond U. Osarogiagbon, Hannah W. Hazard-Jenkins, Don S. Dizon, Jessica J Bian, Michael J. Hassett
Journal: Journal of Clinical Oncology (2022)

241 Background: Monitoring electronic patient-reported outcomes (ePROs) improves quality of life, reduces acute care, and extends survival in cancer patients. Different modalities for collecting ePROs exist. Many efforts focus on mobile apps, but optimal methods for reporting are not well established. We sought to determine whether patient engagement and symptom reporting patterns differed by submission modality. Methods: Through the SIMPRO Consortium, ePRO questionnaires (eSyM) were collected from medical oncology (MO) and surgical (SUR) patients at six health systems between September 2019-March 2022. Questionnaires assessing 12 symptoms plus functional status and overall wellbeing were sent 2-3 times per week via patient portal and made accessible through two modalities: a web platform or mobile device app (mobile). Patterns and predictors of reporting modality were ascertained using descriptive statistics and logistic regression. Results: In total, 6460 patients submitted 47,736 questionnaires: 74% via web and 26% via mobile. Of 2679 MO responders, 53% reported via web, 0.7% via mobile only, and 43% via both. Older, black, and unemployed MO patients were more likely to report via web only. Of 3781 SUR responders, 55% reported via web, 0.3% via mobile only, and 45% via both. Older and unemployed SUR patients were more likely to report via web only; disabled SUR patients were less likely to use web only. Patients utilizing both modalities reported significantly more moderate-severe symptoms than web only responders [Table]. Conclusions: Very few patients reported via mobile only, which was unexpected in the context of trends toward mobile-based patient engagement. Moderate-severe symptoms were reported more frequently by dual-modality responders. Patients with access to both modalities may be more likely to report symptoms in real-time compared to web-users who may delay reporting until they have access to a device. The resulting difference between web and mobile reporting modalities could be due to age, race, and employment; future studies should assess other factors, such as locality and cellular coverage. This work emphasizes the importance of deploying ePROs via multiple modalities to maximize accessibility and response rates. Clinical trial information: NCT03850912. [Table: see text]
Systematic metabolic characterization of mental disorders reveals age‐related metabolic disturbances as potential risk factors for depression in older adults
Authors: Yu Liu, Wanyu Zhao, Ying Lu, Yunli Zhao, Yan Zhang, Miao Dai, Shan Hai, Ning Ge, Shuting Zhang, Mingjin Huang, Xiaohui Liu, Shuangqing Li, Jirong Yue, Peng Lei, Biao Dong, Lunzhi Dai, Birong Dong
Journal: MedComm (2022)

Abstract Mental disorders are associated with dysregulated metabolism, but comprehensive investigations of their metabolic similarities and differences and their clinical relevance are few. Here, based on the plasma metabolome and lipidome of subcohort1, comprising 100 healthy participants, 55 cases with anxiety, 52 persons with depression, and 41 individuals with comorbidity, which are from WCHAT, a perspective cohort study of community‐dwelling older adults aged over 50, multiple metabolites as potential risk factors of mental disorders were identified. Furthermore, participants with mental illnesses were classified into three subtypes (S1, S2, and S3) by unsupervised classification with lipidomic data. Among them, S1 showed higher triacylglycerol and lower sphingomyelin, while S2 displayed opposite features. The metabolic profile of S3 was like that of the normal group. Compared with S3, individuals in S1 and S2 had worse quality of life, and suffered more from sleep and cognitive disorders. Notably, an assessment of 6,467 individuals from the WCHAT showed an age‐related increase in the incidence of depression. Seventeen depression‐related metabolites were significantly correlated with age, which were validated in an independent subcohort2. Collectively, this work highlights the clinical relevance of metabolic perturbation in mental disorders, and age‐related metabolic disturbances may be a bridge‐linking aging and depressive.
Saturday pap smear clinic: Addressing barriers to women’s health.
Authors: Brittany Ann Strelow, Danielle O'Laughlin, Nicole Fellows, Joy Stevens, Stephanie Fink, Anne Stolp, Sonya Peters, Johanna Tweedy, Jordan Ann Anderson, Mollie Francis, Deqa Abdi, Kholood Abuhadid, Gabrielle Gertner, Rachel Olson
Journal: Journal of Clinical Oncology (2022)

105 Background: Screening for cervical cancer with pap smears and HPV testing can improve patient outcomes by allowing for early identification of cervical cancer. The Minnesota Community Measure and Mayo Clinic's goal is to have a cervical cancer screening rate of 82% (Detailed Report-Cervical Cancer Screening, 2020). Healthy People 2030 aims to have a cervical cancer screening rate of 83.4% (Increase the proportion of females who get screened for cervical cancer -C-09, 2021). Community Internal Medicine cervical cancer screening rates are below this level at 63.09% compliance, with 5,239 patients non-compliant, who are eligible for cervical cancer screenings. Olmsted County only offers acute services on the weekends with no primary care services, which leaves women who work during the week or have childcare/caregiver issues with no options on the weekend or evenings when they have availability to attend appointments. Methods: Based on guidelines for pap smear screening (women ages 21-65), 14,195 women were identified within CIM to be eligible for screening. Of those, 5,239 were due for screening. The Saturday Pap Smear Clinic had 88 available spots. We aimed to improve cervical cancer screening rates among non-compliant women within Community Internal Medicine by 1% (52 women, total noncompliant women = 5,239) by January 2021 without adversely impacting coverage of existing clinic hours. Results: The electronic medical record (EMR), EPIC, was utilized to identify all patients who were eligible for a pap smear based on current guidelines (Total eligible = 14,195; Sample size/non-compliant: 5,239 patients) within Community Internal Medicine (CIM) of the Baldwin Building in Rochester, MN. Interventions included: surveys that were sent to patients via the Patient Portal. Advertising for the Saturday Clinic included Primary Care News, E-boards, Posters, Social Media, SCOPE, Mayo News, and Providers. The Saturday clinic allowed time outside the traditional hours. One unique feature of the clinic is that all females staffed it during clinic hours in an attempt to alleviate some of the fear/anxiety. After completion of the pilot Saturday Pap Clinic, pap smear compliance from the Saturday Pap Clinic alone arose 1.2% (62 patients) within CIM. Conclusions: Post-intervention, cervical screening rates among non-compliant women within Baldwin CIM improved by 1.2% (62 women total).
Can we talk about sex? Feasibility of universal sexual health screening for BRCA1/2 patients.
Authors: Amita Kulkarni, Seema Bhoj, Corbyn Mbock Nchako, Muhammad Danyal Ahsan, Melissa Kristen Frey
Journal: Journal of Clinical Oncology (2022)

211 Background: Patients with BRCA1/2 pathogenic variants have an elevated risk for several malignancies including breast and ovarian cancer. Recommended risk-reducing treatments and surgeries can cause sexual dysfunction. Yet, sexual health is often under-addressed among this population. The goal of this initiative was to assess the feasibility and acceptability of implementing universal sexual health screening among BRCA1/2 patients in the outpatient setting. Methods: From 1/2022-6/2022, all patients with BRCA1/2 pathogenic variants in an outpatient Gynecologic Oncology clinic were asked to complete a sexual health symptom questionnaire at their visit. The self-administered screener was distributed by a medical assistant in the waiting room and included a validated single-item screener to assess for sexual dysfunction and questions regarding prior provider discussions about sexual health and how patients wanted to receive information on the topic. The screener was positive if a patient reported at least one symptom related to sexual dysfunction. Results: Thirty-six patients were given the sexual health screening and 100% completed it. The median age was 41 years (range 27-72) and 28 (78%) identified as White and 32 (89%) as non-Hispanic. Fourteen (39%) patients screened positive for sexual dysfunction and 25 (69%) reported never having previously discussed the topic of sexual health with a provider. Among the 14 patients that screened positive for sexual dysfunction, 6 (43%) preferred written educational resources about sexual health and 5 (36%) wanted a follow-up in-person visit. Vaginal dryness, lack of interest, and difficulty with orgasm were the most common patient concerns. Conclusions: Implementing a universal sexual dysfunction screening tool for patients with BRCA1/2 pathogenic variants in the outpatient setting is feasible and acceptable, with 100% participation. Further, over one third of patients screened positive for sexual dysfunction, the majority of whom had never discussed their symptoms with a provider. Future efforts are needed to evaluate scalable strategies to assess and improve sexual health among patients with hereditary cancer syndromes.
Patient preferences for telehealth versus in-person oncology visits.
Authors: Deepika Kumar, Nancy P. Gordon, Elad Neeman, Constanza Zamani, Tammy Rene Sheehan, Ernesto Martin, Jessica Payne, Olga Egorova, Tatjana Kolevska, Raymond Liu
Journal: Journal of Clinical Oncology (2022)

386 Background: The COVID-19 pandemic led to rapid adoption of telehealth (video or phone) visit modalities for oncology encounters not requiring in-person visits. We surveyed oncology patients regarding preferences for in-person versus telehealth modalities for different types of clinical encounters. Methods: We surveyed adults who were undergoing treatment at Kaiser Permanente Northern California infusion centers between 11/2021 – 05/2022 using a self-administered questionnaire. Patients were asked about modality preferences for 6 types of clinical discussions, overall advantages and disadvantages of telehealth versus in-person encounters, and barriers to video visit use. Results: A total of 757 patients who completed surveys in English answered questions about visit modality preferences for different types of discussions with their oncologist. Respondents were 63% female, median age 63y, and majority White (61% White, 19% Asian, 11% Latino, 7% Black) and college-educated (28% some college, 45% ≥ bachelor’s degree). For the first post-diagnosis discussion, most patients preferred in-person (IP) visits (83%), followed by video visits (27%) and phone visits (18%). For follow-up visits during treatment, patients preferred IP (52%), video (50%) and phone (37%) visits. For discussions of bad news and sensitive topics, IP visits were preferred by 68% and 62%, video visits by 44% and 48%, and phone visits by 32% and 41%, respectively. Good news could come at IP (49%), video (52%) or phone (49%) visits. Approximately 20% of patients had no overall preference for IP versus telehealth visits. However, 58% of patients felt more personally connected with their doctor at IP visits. Patients also had more confidence in IP examinations (73%) and felt IP was easier for showing things (67%) and talking (51%) to the doctor. Patients felt telehealth visits saved them time (72%), reduced infection exposure (64%) and travel issues (45%), were cheaper (38%), and enabled inclusion of more people (28%). Of 24% of patients who felt video visits would be hard, 51% cited poor internet, 41% lack of an adequate device, and 28% difficulty signing on. Conclusions: The majority of oncology patients consider telehealth visits acceptable for most types of clinical discussions, with the exception of the first post-diagnosis visit. Only one-fourth of patients indicated potentially modifiable barriers to video visits. Our results support use of telehealth visits for most types of oncology encounters.
Comparison between subjective and objective fatigue in patients with lung cancer and cancer-free participants: Evaluation of diagnostic criteria for cancer-related fatigue.
Authors: Tsai-Wei Huang, Chi-Huang Shih, Pai-Chien Chou, Ting-Ling Chou
Journal: Journal of Clinical Oncology (2022)

440 Background: Cancer-related fatigue is one of the most distressing symptoms of cancer patients. Finding a patient's fatigue often requires the use of a subjective assessment scale, such as the Brief Fatigue Inventory (BFI). There are few objective ways to measure fatigue. The aim of this study was to evaluate whether objective cancer-related fatigue (CRF) diagnostic criteria can differentiate cancer from cancer-free participants and to explore the relationship between subjective and objective fatigue. Methods: In this study, we used a photoplethysmography (PPG) smartband device to collect the PPG information from the patients. During PPG measurements, the heart rate variability (HRV) signal was included in the data collection process for subsequent calculation of the LF/HF ratio. Participants completed a self-report measure to assess demographics, fatigue levels, and brief sleep diaries for the next 7 days. At the same time, the participants wore a wristband to collect HRV signals, which triggered HRV every hour over a 24-hour period for 7 consecutive days. Results: Cancer patients (n = 71) and cancer-free controls (n = 75) were studied. Study participants completed CRF questionnaires and heart rate variability (HRV) records. The smartband can be worn continuously for 120 hours as an objective measure of activity phase, sleep phase and HRV. Compared with controls, cancer patients were more fatigued and were more likely to be disturbed by fatigue (t = -3.73, p &lt; 0.001), especially general activity (t = -2.93, p &lt; 0.001), walking ability (t = -3.6, p &lt; 0.001) and normal work (t = -2.18, p = 0.03). Wearing the bracelet can get the LF/HF value of HRV in the time domain. The LF to HF and LF/HF disorder ratios were further divided into active and sleep phases. During sleep phase, the LF/HF disorder ratio was higher in the cancer group than in the control group regardless of whether fatigue was mild or moderate (t = -2.5, p = 0.01; t = -2.8, p = 0.01, respectively). The LF/HF disorder ratios was higher in cancer patients with mild fatigue than in cancer-free participants during sleep phase (40% vs 20%, respectively). Cancer patients with moderate fatigue had higher incidence of LF/HF disorder ratios than cancer-free participants (50% vs 20%, respectively). Conclusions: It can be concluded that the diagnostic criteria of subjective and objective CRF can distinguish cancer and cancer-free cases. Using this objective fatigue device could provide an indicator for further clinical monitoring. Clinical trial information: NCT04300842.
Do clinical pathways impede provider workflow: A provider efficiency analysis of time spent using an EHR-embedded clinical decision support tool.
Authors: Rebecca Maniago, Jennifer Miao, Stephanie Jou, Gregory Sampang Calip, Shawn Huda, Lawrence N. Shulman, Erin Mary Bange, Aditi Puri Singh, Christopher Davella
Journal: Journal of Clinical Oncology (2022)

381 Background: With the growing complexity and cost of cancer care, adoption of oncology pathway tools as clinical decision support (CDS) has increased at the point of care. These tools have been shown to improve care quality, reduce variations in care and reduce healthcare costs. Flatiron Assist (FA) is a customizable CDS tool that is embedded in the electronic health record (EHR) to facilitate selection and documentation of National Comprehensive Cancer Network (NCCN) guideline concordant cancer treatment regimens. The time burden of engaging with CDS tools is a top concern for clinicians and often limits uptake of these tools. However, data on the actual time spent utilizing these tools in clinical practice is limited. Our study reports on the time spent by clinicians in various oncology practices, utilizing and ordering cancer treatment regimens with a CDS tool. Methods: We reviewed all completed sessions in FA from July 23, 2021 to May 23, 2022 by 878 prescribers at 24 academic and community oncology centers. Sessions that were part of an electronic prior authorization pilot program were excluded for purposes of standardization. Session length was defined as the time from the completion of application launch to application exit. For prescribers who completed over 20 sessions, we compared the mean sessions lengths of user’s initial sessions (#1-10) to subsequent sessions (#11-20) using paired t tests. We also determined the total number of potential CDS tool sessions per user per week. Results: All 14,394 CDS tool sessions were analyzed during the 10 month observation period. Median session length was 42 seconds (95th percentile, 253 seconds or 4.2 minutes). The average number of treatment orders placed was 5 per week per provider. Table shows the median session length across the 9 most commonly treated cancers. For the 31 prescribers who started using FA during the study and completed more than 20 sessions, the mean (SD) session length decreased from 95.2 (11.8) seconds in sessions #1-10 to 71.0 (6.0) seconds in sessions #11-20 (two-sided P = 0.034). Conclusions: Utilization of FA as a CDS tool to provide guideline concordant care is feasible and adds less than 4 minutes/week on average to a provider’s workflow. When used effectively, it can integrate seamlessly into provider workflows across academic and community practices without disruptive increases in time or effort of cancer treatment regimen ordering. Future studies are needed to evaluate the impact of product improvements, content changes, and electronic prior authorization integrations on time in this workflow.[Table: see text]
Measuring integrated team-based oncology care: Developing a novel chart abstraction tool.
Authors: Robin Richardson, Rebekkah Schear, Rebecca Munoz, Elizabeth Ann Kvale
Journal: Journal of Clinical Oncology (2022)

316 Background: In December 2018, the Livestrong Cancer Institutes (LCI) launched the CaLM Model of Whole-Person Cancer Care. Compared to traditional models of oncology care, CaLM offers integrated interdisciplinary supportive care. As team-based care delivery models like CaLM begin to become more predominant, health IT infrastructure and systems are failing to adequately capture and measure simple clinical data on team-based encounters. Athena, our EHR, lacked discrete fields to capture necessary data from shared appointments in order to evaluate patient utilization of team-based longitudinal care; requiring us to develop a manual chart abstraction to evaluate the clinical model. Methods: We performed a literature review and environmental scan on chart abstraction for team-based care. When limited results were found, we sought to develop a novel tool in REDCap. We developed a list of variables and domains that required measurement and worked with IT to determine which, if any, could be generated automatically in reports in the Athena EHR. Remaining domains (12 domains and 151 unique data points) were strategically embedded in a methodological abstraction tool that mapped closely to the logic and flow of the EHR. We tested the tool and iterated over three months in 2019. Before abstraction began, we developed and executed a two module, four hour training for data collectors to ensure quality data collection. Over a one year period, four abstractors pulled data from over 400 individual patient charts in the EHR. Results: We developed a unique two-phase quality assurance (QA) algorithm. Phase 1- We randomly selected 10% of patient records; two abstractors completed dual data entry (same chart). Dual data entry controls for discrepant values that can be common in large datasets. A third-party team reviewed both charts, recording discrepancies by category, harmonizing charts, and data was used to retrain data collectors during weekly meetings. Highest discrepancies occurred when documenting treatment history (95%). For 89% of records, there were differences in psychosocial utilization. As a result of these discrepancies, we opted to extend QA- the remaining 90% of records were reviewed by third party scanning half of domains for accuracy. The chart abstraction was successfully completed on over 400 patient charts; the process took over 18 months to complete. Conclusions: Analyzing patters of team-based care is likely a manual process, regardless of EHR vendor. Our tool is well-structured with the ability to be open source, so that other clinics can utilize our tool in lieu of replicating the same painstaking process.